Manager, Clinical Pharmacy Operations

Centene; United States; Remote; USD 108,000 - 199,000; Full time

Benefits offered by this job

Comprehensive benefits

Remote/Hybrid/work options

401K and stock plans

Job summary

Centene is seeking a Manager of Clinical Pharmacy Operations for a remote role serving the Louisiana Medicaid program. The position requires LA residency, supervisory responsibilities for three staff, and collaboration with regulators, health plans, Government Relations, and finance teams.

The role emphasizes leadership, program development, formulary and DUR oversight, and compliance with Louisiana policies. Strong MS Office proficiency and prior PBM/managed care experience are a plus.

Qualifications

• Doctor of Pharmacy degree from an accredited school.
• One to three years clinical pharmacy experience including formulary development, drug utilization review, and/or medication therapy management.
• Four years progressively responsible positions within managed care pharmacy with a minimum of two years in a management role.
• Public speaking experience.

Responsibilities

• Directs clinical pharmacy activities through subordinate staff to enhance quality of pharmaceutical care and cost-effective utilization for members.
• Develops, implements and maintains clinical pharmacy programs including quality assurance, formulary management, drug utilization review, compliance and education.
• Coordinates clinical efforts with other departments to ensure cohesive programs.
• Performs QA monitoring of staff to ensure best practices and compliance with regulatory standards (Medicare Star, HCQA/HEDIS).
• Oversees and/or develops clinical recommendations for Pharmacy and Therapeutics committee approval.
• Monitors clinical advancements to ensure appropriate coverage of safe, effective pharmaceuticals and program implementation.
• Oversees compliant administration of the pharmacy benefit.
• Acts as liaison to outside agencies/providers and primary contact for clinical pharmacy issues.
• Performs other duties and complies with policies and standards.

Skills

Leadership

Change management

Managed care experience

PBM experience

Public speaking

Project management

Communication

Microsoft Office

Education

Doctor of Pharmacy degree

Tools

Microsoft Office

Job description

Position Purpose: The Manager of Clinical Pharmacy Operations is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals.

Key Details : This remote Pharmacist position supports the Louisiana Medicaid pharmacy program and requires candidates to reside in Louisiana. This position leads three direct reports, including a pharmacist, pharmacy coordinator, and project coordinator. The role operates Monday through Friday during Central Time business hours and serves as a pharmacy subject matter expert, partnering with Louisiana Medicaid regulators, health plan executive leadership, Government Relations, Quality, Finance, and Actuarial teams on regulatory requirements, pharmacy initiatives, quality measures, financial planning, and member health outcomes. Responsibilities include supporting Government Relations with pharmacy-related legislative talking points and meetings as needed, collaborating on provider engagement and clinical strategies, participating in monthly Lag Prep and pharmacy metric reviews, ensuring compliance with Louisiana clinical policy guidelines and Drug Information requirements, maintaining policies and procedures for Medicaid pharmacy business processes, and monitoring CPS compliance with the Louisiana Medicaid contract. The ideal candidate will bring strong leadership and employee engagement skills, the ability to effectively lead through change, and significant managed care experience, preferably within pharmacy health plan leadership. Previous PBM experience is a plus, along with proficiency in all Microsoft Office applications

• Directs and manages clinical pharmacy activities through subordinate staff to enhance the quality of pharmaceutical care and promote cost-effective utilization of pharmaceuticals for members.
• Responsible for the development, implementation and ongoing maintenance of clinical pharmacy programs including but not limited to clinical quality assurance programs, formulary management, drug utilization review, compliance and/or education.
• Coordinates clinical efforts with other department functional areas to ensure implementation of cohesive programs.
• Performs quality assurance monitoring of staff to ensure best practices are met and validates that clinical pharmacy programs meet applicable regulatory and compliance standards, such as Medicare Star ratings, HCQA HEDIS measures, and/or regulations, etc.
• Oversees and/or develops clinical recommendations and guidelines for approval by the Pharmacy and Therapeutics committee
• Monitors clinical advancements and changes in evidence-based pharmacy practice to ensure appropriate coverage of the safest and most effective pharmaceuticals and/or implementation of effective programs.
• Oversees compliant administration of the pharmacy benefit.
• Acts as clinical pharmacy liaison to outside agencies and providers as well as the primary point of contact for responsible area on clinical pharmacy issues as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Doctor of Pharmacy degree from an accredited school. One to three years clinical pharmacy experience including formulary development, drug utilization review, and/or medication therapy management. Four years progressively responsible positions within managed care pharmacy with a minimum of two years in a management role. Public speaking experience.

Additional requirement for the state of Louisiana: The pharmacist must reside in Louisiana, hold an active Louisiana pharmacist license, work full-time and have at least five (5) years of experience practicing as a pharmacist in a retail setting, including managerial experience. Ability/willingness to travel to Baton Rouge, Louisiana as required.

License/Certification: Must have and maintain current, valid and unrestricted Registered Pharmacist License in the state of LA.

Pay Range: $107,700.00 - $199,300.00 per year

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Cen